Antithrombotic therapy for elective percutaneous coronary intervention: General use
- Donald Cutlip, MD
Donald Cutlip, MD
- Section Editor — Interventional Cardiology
- Professor of Medicine
- Harvard Medical School
- Beth Israel Deaconess Medical Center
- Thomas Levin, MD
Thomas Levin, MD
- Illinois Heart and Vascular
- Chicago, Illinois
Percutaneous coronary intervention (PCI) disrupts the coronary endothelium, leading to the exposure of subendothelial tissue factors to blood. Intracoronary thrombosis may result during or soon after the procedure. In addition, metal (which is procoagulant) stents can trigger thrombus formation. Stent thrombosis can be a life-threatening event. (See "Coronary artery stent thrombosis: Clinical presentation and management" and "Coronary artery stent thrombosis: Incidence and risk factors".)
Aggressive antithrombotic therapy with aspirin, platelet P2Y12 receptor blockers, glycoprotein (GP) IIb/IIIa inhibitors, and parenteral anticoagulants is used to decrease the risk of early intracoronary thrombosis. Recommendations for the use of these agents in stable patients before and within the first few days of stent placement will be the focus of this topic. The studies supporting these recommendations are presented separately. (See "Antithrombotic therapy for elective percutaneous coronary intervention: Clinical studies".)
The discussion of the long-term use of aspirin and platelet P2Y12 receptor blockers to prevent late and very late stent thrombosis is found elsewhere. (See "Long-term antiplatelet therapy after coronary artery stenting in stable patients".)
The use of antithrombotic therapy in the setting of acute coronary syndromes (ACS) is discussed elsewhere. (See "Antiplatelet agents in acute ST elevation myocardial infarction" and "Antiplatelet agents in acute non-ST elevation acute coronary syndromes" and "Anticoagulant therapy in non-ST elevation acute coronary syndromes" and "Anticoagulant therapy in acute ST elevation myocardial infarction".)
We prescribe antithrombotic therapy to stable patients undergoing elective PCI with stenting in the following sequential manner:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- OUR APPROACH
- P2Y12 RECEPTOR BLOCKERS
- Evidence regarding timing and dose
- Patients already taking clopidogrel
- Possible coronary artery bypass graft surgery
- Problems with clopidogrel use
- GP IIb/IIIa INHIBITORS
- Risk for bleeding
- Choice of agent
- - Dosing and monitoring
- - Use with GP IIb/IIIa inhibitors
- - Postprocedural management
- - Heparin-induced thrombocytopenia
- PATIENTS TAKING LONG-TERM ORAL ANTICOAGULATION
- PATIENTS UNDERGOING BALLOON ANGIOPLASTY
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS